Principle: | Clinical Significance: | Specimen: | Materials: | Reagents: | Standardization: N.A. | Procedure: | Limitations: N.A. | Results Derivation: | Expected result(s) | Quality Control: | References:
Donor red blood cells and recipient plasma/serum are mixed together and observed for any possible reaction to detect recipient antibodies to donor antigens. When a patient has had a clinically significant antibody(ies) identified, currently or in the past, blood lacking the relevant antigen(s) should be selected. Crossmatches for these patients must incorporate the antiglobulin phase even if the antibody has dropped to below detectable levels.
II. Clinical Significance:
The primary purpose of compatibility testing is to assure the best possible results of a blood transfusion, i.e. the transfused red cells will have an acceptable survival rate and that there will be no significant destruction of the recipient’s own red cells. Although adverse responses to transfusion cannot always be avoided, results are much more likely to be favorable if pretransfusion testing is carefully performed and the results of that testing indicate no demonstrable incompatibility between donor and recipient.
Refer to “General Processes, Blood Bank” protocol.
Refer to “General Processes, Blood Bank” protocol for vendor, product number and storage information.
1. 12 x 75 mm test tubes
2. Hematype Segment Device
3. Graduated transfer pipettes
4. MTS Incubator
5. MTS Centrifuge
7. MTS Pipette tips
8. MTS Diluent Dispenser
9. 10 µl Pipettor, Rainin
10. White or yellow pipette tips
11. Gel Card Reading Backdrop
12. Marking Pen (water resistant)
13. Rubber bands
14. Blood Bank Worksheets (downtime use only)
15. Blank Product ID Tag (downtime use only)
16. Blank Product ID Labels (downtime use only)
Refer to “General Processes, Blood Bank” protocol for vendor and product information.
1. Blood Bank Saline (0.85%)
2. MTS DILUENT 2®
3. MTS Anti-IgG Gel Card®
VI. Standardization: N.A.
Warning: If the patient's antibody screen was positive, any compatible unit must be antigen typed for the corresponding antigen and only antigen negative units would be considered compatible and released. Refer to “Antigen Typing” protocol.
1. Check the patient record to determine if the patient has pre-deposited any autologous unit(s) or enlisted any Directed Donor(s). Crossmatch and release these units first.
2. Check if the patient has been previously typed and determine if any prior antibody(ies) has been identified in this patient. See SafeTrace Tx® “Patient at a Glance” bar.
3. Determine the patient ABO group and Rh type. Refer to the “ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards” procedure.
4. Select the donor units. Refer to the “Donor Selection” procedure.
5. Crossmatches (MTS IgG Gel Card):
A. Prepare a 0.8% suspension of the donor red cells for crossmatch as follows:
a. Label two 12 x 75 mm test tubes with the appropriate identifying unit numbers for each donor unit selected.
b. Prepare donor red cells for crossmatch:
1. Remove a sealed segment(s) of tubing integral with the blood bag(s) and place in the appropriately labeled test tube.
2. Take the sealed segment out of the first tube and place a Hematype Segment Device on top of that tube. While covering the top end of the segment with gloved hand, insert the other end of the segment into the Hematype Segment Device, puncture end, and squeeze to dispense donor cells. Hold the Hematype Segment Device with segment still in place and discard into a biohazard container.
3. Allow the donor cells to pool at the bottom of the test tube.
4. Dispense 1.0 ml of MTS Diluent 2® into the second labeled test tube by using the 0.5 ml MTS diluent dispenser and slowly dispensing 2 premeasured aliquots.
5. Aspirate 10µl of the donor cells from the donor cell test tube with the 10 µl Rainin Pipettor
6. Wipe the tip dry.
7. Deliver the 10 µl of the donor cells into the labeled diluent tube by the forward rinse technique.
8. Mix by gentle agitation.
9. Save the donor cell test tube with the remainder of the donor cells until testing is completed.
B. Label an MTS Anti-IgG Gel Card® with the unit number(s) and a patient identifier (name, number, or initials).
C. Remove the foil seal from as many microtubes as needed.
D. Set the DiaMed ID-Pipettor/ID-Tipmaster to deliver 50 µl.
E. Mix the cell/diluent suspension again by slowly aspirating and dispensing the suspension with the Pipettor.
F. Aspirate enough of the well-mixed 0.8% donor cell suspension with the DiaMed ID-Pipettor/ID-Tipmaster to discard a portion as a primer and still be able to deliver a 50 µl aliquot.
G. Deliver the 50 µl of the 0.8% donor cell suspension into a microtube on the appropriately labeled Gel Card.
H Set the DiaMed ID-Pipettor/ID-Tipmaster to deliver 25 µl.
I. Aspirate enough of the patient plasma/serum with the DiaMed ID-Pipettor/ID-Tipmaster to discard a portion as a primer and still be able to deliver a 25 µl aliquot.
J. Add 25 µl of patient plasma/serum to the appropriate microtube(s).
K. Read and record the temperature of the Gel Card incubator.
L. Incubate the Gel Card at 37°C for 15 minutes. (Incubation may be extended to 30 minutes.)
M. Centrifuge the Gel Card for 10 minutes.
N. Read the front and the back of each microtube macroscopically and record the reaction. (Refer to the policy: “Reading and Grading Reactions; Blood Bank”.)
O. Affix the computer generated Product ID Labels(s) directly onto the component bag(s). Attach the computer generated Product ID Tag(s) to the component bags with a rubber band.
P. If the computer is down, complete blank Product ID Label(s) to affix to the component bag(s) and a Product ID Tag(s) to attach to the component bag(s) with a rubber band.
6. Non-Routine Methods Crossmatches:
Warning: Patient plasma/serum treated with certain adsorption techniques (i.e. HPC, WARM, REST) may not be used for crossmatching.
Prewarmed Technique; MTS IgG Gel Card:
Note: Used primarily for patients presenting with nonspecific cold antibodies.
Refer to the “Antibody Detection, Crossmatch and ID, Prewarm; MTS Gel Card” procedure.
VIII. Limitations: N.A.
IX. Results Derivation:
1. COMPATIBLE: No agglutination or hemolysis seen, indicating the absence of an antigen/antibody reaction.
2. INCOMPATIBLE: Agglutination or hemolysis seen, indicating the presence of an antigen/antibody reaction.
Note: Incompatibility problems must be resolved before the issuance of any units.
X. Expected result(s) and or critical values:
XI. Quality Control:
1. Quality control is performed on reagents and reagent cell suspensions each day of use and as new vials/lots are opened. Refer to the “Blood Bank Reagents; Quality Control” protocol. Instruments and equipment are tested as prescribed in the Maintenance and Function Verification procedures.
2. An antibody screen is performed with each fresh plasma/serum sample to detect any unexpected antibodies in the patient plasma/serum. (Refer to the “Antibody Detection & Identification; MTS Gel Card” procedure.)
1. Committee on Standards. "AABB Standards for Blood Banks and Transfusion Services". American Association of Blood Banks, Washington, D.C., current edition.
2. Technical Manual. Bethesda, MD: American Association of Blood Banks, current edition.
3. Package Insert: Anti-Human Globulin Anti-IgG (Rabbit) MTS Anti-IgG Card®. Pompano Beach, FL: Micro Typing Systems, Inc. current version.
4. Package insert: MTS Diluent 2® Red Blood Cell Diluent. Pompano Beach, FL: Micro Typing Systems, Inc. current version.
5. Ortho Compatibility procedure: Ortho current version.
6. Conversations with Ortho Research Staff (Susan South), current version.
7. Dr. Edmonds / Laboratory Test Handbook 1/92.
8. Hematype Segment Device, package insert.
i. August 1996 S. Rodriguez/N. Combs
ii. December 1997 S. Hosch (Revised: V.2.).
iii. January 2001 N. Combs/S. Hosch (Revised: II., III., IV.,V.,VII., X., XI.)
iv. June 2001 M. Burger (Revised: III., IV., VII.2., XII.)
v. September 2002 M. Burger, N. Combs (Revised: I., III., IV., V., VII.1-2, 4, 5.A.a., 9., 5.O., 6., XII.)
vi. December 2008 N. Combs (Revised: IV.16.added; VII.5.O-P.)
Interim Review: September 2009 S. Hosch (no changes)